Current status of cardiac rehabilitation in Latin America and the Caribbean.

BACKGROUND: The prevalence of coronary artery disease (CAD) in Latin America is increasing and contributes importantly to the global burden of cardiovascular diseases. Advanced resources for the diagnosis and treatment of CAD are available in most of the region. However, preventive approaches such as cardiovascular rehabilitation programs (CVRP) may not be widely implemented. METHODS: We carried out a telephone-based survey to hospitals sampled in a random and population-weighted fashion from a list of 202 centers with cardiac catheterization laboratories in Mexico, Central and South America, and the Caribbean. We collected information of availability of cardiac procedures and imaging techniques and also extensive data about the presence, characteristics, and quality measures of CVRP. RESULTS: A total of 98 centers were contacted, and a complete survey was provided by 59 centers (60%) from 13 countries. Cardiovascular rehabilitation programs were available in only 56% of centers. There were no differences between centers with and without CVRP regarding type of hospital, availability of cardiac surgery, and annual volume of patients with myocardial infarction. Among centers with CVRP, 70% offered all phases of CVRP. The lack of CVRP was attributed to lack of qualified personnel in 41% of centers, financial constraints in 33%, and lack of physical space in 13%. All centers without CVRP performed cardiac surgery and percutaneous interventions. CONCLUSIONS: Despite the presence of state-of-the-art technology for the diagnosis and treatment of CAD, availability of CVRP, a less expensive yet effective tool for the treatment of CAD, appears to be limited in Latin America and the Caribbean.

Diferencias en el impacto de los componentes del síndrome metabólico entre la población hipertensa latinoamericana y la española / Differences on the contribution of specific components of the metabolic syndrome between hypertensive Latin American and Spanish patients

Fundamento y objetivo: El objetivo del presente trabajo ha sido evaluar la existencia de diferencias en la aportación de los distintos componentes del síndrome metabólico (SM) en hipertensos de Latinoamérica y de España. Pacientes y método: Estudio transversal en 632 hipertensos afectados de SM seleccionados en Argentina, Brasil, España, México, Chile, Venezuela y Colombia. Se determinaron las características demográficas, así como el impacto de los componentes que definen el SM en función del país de procedencia de los individuos. Resultados: La edad media fue de 55 años (desviación estándar de 14), con un 54% de mujeres. Tres criterios de SM estaban presentes en el 38%, 4 en el 40% y los 5 en el 22%. No se observaron diferencias entre los países en los valores de triglicéridos. Los pacientes procedentes de Brasil, México y España presentaban valores más elevados de glucemia en ayunas. Las mujeres procedentes de Venezuela y Brasil tenían valores más elevados de perímetro de cintura, mientras que las procedentes de Venezuela y Chile tenían valores más bajos de cHDL (cholesterol high-density lipoproteins‘colesterol unido a lipoproteínas de alta densidad’). Al evaluar la proporción de pacientes con elevación de cada uno de los componentes del SM, los procedentes de Venezuela presentaban en mayor proporción cifras bajas de cHDL (77%) y elevadas de triglicéridos (83%), mientras que en los procedentes de España estos porcentajes eran los más bajos (40% y 56%, respectivamente). Conclusiones: Los componentes del SM tienen un impacto similar independientemente de los países de procedencia. No obstante, se observan algunas diferencias sutiles, de forma que donde predominan las alteraciones lipídicas (mayores en Venezuela y menores en España) las alteraciones de la glucemia son menos evidentes (menor proporción en Venezuela y mayor en España) (AU)

Background and objective: The aim of the present study was to evaluate possible differences in the impact of the components of metabolic syndrome (MS) on hypertensive patients from countries in Latin America and Spain. Patients and method: Cross-sectional study in 632 hypertensives with MS recruited in Argentina, Brazil, Spain, Mexico, Chile, Venezuela and Colombia. Demographic and clinical data, as well as the impact of every single component of the MS were evaluated and compared depending on the country they came from. Results: Mean age was 55(14) years, with 54% females. Thirty-eight percent presented 3 MS criteria, 40% presented 4 criteria, and 22% all the 5 criteria. There were no differences among countries in relation to triglyceride mean values. Subjects from Brazil, Mexico, and Spain showed the highest values of fasting plasma glucose. Women from Venezuela and Brazil showed the highest values of waist circumference and women from Venezuela and Chile the lowest values of HDL-cholesterol. With respect to the proportion of patients with each component alteration, those from Venezuela showed the highest proportion of hypertriglyceridemia (83%) and low HDL-cholesterol (77%), whereas those from Spain exhibited the lowest (56% and 40%). Conclusions The impact of the components of MS is relatively homogeneous in Latin-America and Spain. However, some differences are detected, with atherogenic dyslipidemia being the predominant factor in Venezuela and abnormal fasting plasma glucose the main one in Spain (AU)

Revisión contemporánea: hipertensión pulmonar / Contemporary review: pulmonary hypertension

El término hipertensión pulmonar comprende un grupo heterogéneo de condiciones con la capacidad común de generar incremento progresivo de la presión arterial pulmonar y cuyo resultado final puede derivar en dilatación ventricular derecha, falla cardíaca derecha y muerte. La hipertensión arterial pulmonar es una de sus formas y en las últimas décadas se ha producido un creciente interés sobre esta patología. En parte, mucho es debido al desarrollo y diponibilidad de tratamiento farmacológico e intervensiones específicas para una situación en la que, anteriormente, se contaba con limitados recursos terapéuticos y pronóstico invariablemente sombrío.

The term pulmonary hypertension encompasses a group of heterogeneous conditions with the common capacity to generate progressive increase in pulmonary arterial pressure for wicg the final result may derive in right heart dilatation, failure and death. Pulmonary arterial hypertension is one of its forms and in the last decadens a growing interest for this pathology has been encountered. This is largely due to the development and disposal of pharmacological treatment and specific interventions for a situation for which, in the past, limited resources were available and prognosis was invariably poor.

[Differences on the contribution of specific components of the metabolic syndrome between hypertensive Latin American and Spanish patients]. / Diferencias en el impacto de los componentes del síndrome metabólico entre la población hipertensa latinoamericana y la española.

BACKGROUND AND OBJECTIVE: The aim of the present study was to evaluate possible differences in the impact of the components of metabolic syndrome (MS) on hypertensive patients from countries in Latin America and Spain. PATIENTS AND METHOD: Cross-sectional study in 632 hypertensives with MS recruited in Argentina, Brazil, Spain, Mexico, Chile, Venezuela and Colombia. Demographic and clinical data, as well as the impact of every single component of the MS were evaluated and compared depending on the country they came from. RESULTS: Mean age was 55(14) years, with 54% females. Thirty-eight percent presented 3 MS criteria, 40% presented 4 criteria, and 22% all the 5 criteria. There were no differences among countries in relation to triglyceride mean values. Subjects from Brazil, Mexico, and Spain showed the highest values of fasting plasma glucose. Women from Venezuela and Brazil showed the highest values of waist circumference and women from Venezuela and Chile the lowest values of HDL-cholesterol. With respect to the proportion of patients with each component alteration, those from Venezuela showed the highest proportion of hypertriglyceridemia (83%) and low HDL-cholesterol (77%), whereas those from Spain exhibited the lowest (56% and 40%). CONCLUSIONS: The impact of the components of MS is relatively homogeneous in Latin-America and Spain. However, some differences are detected, with atherogenic dyslipidemia being the predominant factor in Venezuela and abnormal fasting plasma glucose the main one in Spain.